Claim total
$1,152.44
base $93.83 · payer covered $1,152.44
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2012-10-14
- Stop
- 2012-10-14
The parties
- Patient
- patient Faustino Romeo Bauch
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Dual Eligible
Record id
03e24eff-3793-eaeb-377e-726e3dea68eb